HomeMy WebLinkAboutCLE201600185 Application 2016-08-18Application for Zoning Clearance``
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OFFICE USE ONLY p.
PLEASE REVIEW ALL 3 SHEETS Check # Date: O �7
Receipt # (0 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 056A2-01-00-07000 Existing Zoning yes
Parcel Owner: PIEDMONT REALTY HOLDINGS III LLC
Parcel Address: 2025 LIBRARY AVE City Crozet State VA Zip 22932
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Shawn Miller
Address: 5586 Summerdean Rd. City Crozet State VA Zip 22932
Office Phone: (336) 508-7421 Cell # same Fax # n/a E-mail shawnmiller3@gmail.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name V New business
Business Name/Type: BeerWne/Gourmet
Previous Business on this site none
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: We'll sell beer/wine and gourmet items. Two employees
We'll use one vehicle at a time. Number of parking spaces is unavailable at this time.
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accur e t e best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Shawn Miller
APP AL INFORMATION
[ pproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes
Building Official Date - C.
Zoning Officialptin
Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of
Intake to complete the following:
Y / N�
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/❑N
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or ublic water?
If private well, provide Health Department form.
Zoning review can not -begin until we receive approval from Health
Dept. FAX DATE _
Circle the one that ap lies
Is parcel on septic or public sewer.
Y 'u
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit
YIN❑
Will there be any new construction or renovations?
If so, obtain the amper Pe t.
Permit # 1 el
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: _
� rmitted
Under Section: Oftl'
Supplementary regulations section:
Parking formula: 1
OC-P heoo Wf -
Required spaces:
YI
Item o be verified in the field:
100,
Violations:
YIN
If so, List:
Proffers:
YIN
If so, List:
Variance:
YIN
If so, List:
l
SP's:
YIN
If so, List:
Clearances:
SDP's
Revised 11/1/2D15 Page 3 of
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application, B201600037NC
[County application name and number]
was provided to PIEDMONT REALTY HOLDINGS III LLC
[name(s) of the record owners of the parcel]
and Parcel Number 056A2-01-00-07000
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
on
Date
0 Mailing a copy of the application to Drew Holzwarth
[Name of the record owner if the record owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity]
on 8/4/2016
Date
to the following address:
6535 WOODBOURNE LN, CROZET VA, 22932
[address; written notice mailed to the owner at the last known address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of A ant
Shawn Miller
Print Applicant Name
8/4/2016
Date
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